ICA Youth "LEAD" Program Application
Join us for an unforgettable trip to Kashmir!
Applicant Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
School
*
Grade (as of Fall 2024)
*
Birthdate
-
Month
-
Day
Year
Date
Gender
Male
Female
Other
Which Indian languages can you speak proficiently, if any?
Hindi
Marathi
Other
Parent or Guardian Information
Parent/Guardian #1 Name
*
First Name
Last Name
Parent/Guardian #1 Phone Number
*
-
Area Code
Phone Number
Parent/Guardian #1 Email
*
example@example.com
Parent/Guardian #2 Name
First Name
Last Name
Parent/Guardian #2 Phone Number
-
Area Code
Phone Number
Parent/Guardian #2 Email
example@example.com
Prior Experience
Do you have previous work, internship, or volunteer experience?
*
Yes
No
Organization/Business #1
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Supervisor
First Name
Last Name
Supervisor Email
example@example.com
Roles and Responsibilities (50-75 words)
0/75
Do you have additional experience you'd like to share?
Yes
No
Organization/Business #2
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Supervisor
First Name
Last Name
Supervisor Email
example@example.com
Roles and Responsibilities (50-75 words)
0/75
Why do you feel you are a good fit for the ICA Youth "LEAD" Program? How will this experience benefit you? (up to 400 words)
*
0/400
Travel
Are you available to travel to India?
*
Yes
No
Do you have or will you be able to obtain the proper documentation to travel outside of the United States (i.e. passport)?
*
Yes
No
Do you have or will you be able to obtain the proper documentation to travel to India (i.e. visa)?
*
Yes
No
Please list any travel complications that you anticipate.
Please list any allergies or health concerns that you have.
We will need signatures on this form when we meet in person at Orientation
*
Deposit
*
prev
next
( X )
Mandatory Deposit
$
100.00
This deposit holds your spot in the 2024 program
Total
$
0.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
Should be Empty: